RESEARCH HIGHLIGHTS

NIH-Funded Study to Improve Chronic Care Management

As much as 75 percent of the nation’s health care dollars goes toward the treatment of chronic diseases such as diabetes and heart disease, according to the CDC. Yet, outcomes and care satisfaction in these patients are less than optimal. With the help of a four-year, $1.3 million grant from the National Institutes of Health, a team of researchers from the WSU College of Nursing and the Department of Health Policy and Administration is looking to change this.

Working with Aging and Long Term Care of Eastern Washington and the Community Health Association of Spokane, the researchers will be testing the effectiveness of a chronic care management intervention aimed at increasing patients’ abilities to manage their own conditions and reducing hospitalizations.

“People will sometimes use hospital emergency departments rather than following up with their primary care provider,” said Cindy Corbett, professor of nursing and principal investigator on the study. “Not only is this much more costly, it also leads to a yo-yo style of care that lacks continuity, because you see a different person every time.”

For a year, the research team will follow 300 older adults with multiple chronic illnesses who are frequent users of hospital services. One group will receive an active intervention that includes an individualized assessment and frequent follow-up visits and phone calls from a nurse and a social worker, who will promote the use of community resources and help them better work with their health care providers. The other group will be provided limited referral support by a health care paraprofessional. The research team will monitor emergency department use and hospitalizations in the two groups throughout the year.

“Our hope is that this intervention will help keep patients out of the hospital and improve their quality of life,” Corbett said.

Discovery Improves Potential for Drowsy Driver Detection

According to a CDC study released earlier this year, one in nine Americans have fallen asleep behind the wheel in the past year.

Car manufacturers are taking note. Certain car models now come with video-based drowsy driving warning systems that detect when the car drifts out of its lane. However, these systems have been tested primarily in drivers with high levels of fatigue and are not as reliable during bad weather, in darkness, or when lane markers are missing, says research professor Hans Van Dongen of the WSU Sleep and Performance Research Center. A discovery made by him and his team opens the door to the development of an alternative that would detect drowsiness at more moderate levels of fatigue, well before an accident is likely to happen.

They analyzed data from two laboratory studies that had participants on a simulated 10-day night-shift schedule that caused moderate levels of fatigue. Participants drove a high-fidelity driving simulator during four 30-minute driving sessions each night shift. Out of 87 driving metrics measured, two best predicted fatigue: steering wheel movements and lateral lane deviation.

They also showed that variability in steering wheel movements commonly precedes lateral lane deviation, which suggests that the former provides a solid basis for the development of an early detection system for driver drowsiness. Findings were published in the journal Accident Analysis and Prevention with postdoctoral fellow Pia Forsman as the lead author. A patent application is pending.

Addressing E-Cigarette Safety Concerns

Tobacco smokers looking to quit or reduce the harmful effects of their smoking habit are increasingly looking to electronic cigarettes as a solution. Although there hasn’t been much research on e-cigarette smoking to date, studies done so far suggest that it may deliver nicotine in a less toxic manner than tobacco smoking. However, the lack of safety regulations on e-cigarette refill solutions is a concern, say researchers from the WSU Program of Excellence in the Addictions.

In a recent study, assistant professor of nursing Donelle Howell and her team tested the nicotine content of seven e-cigarette solutions marked with different nicotine concentration levels (low, medium, high, and super high). The good news: although they found varying amounts of nicotine, they were equal or lower to what was expected based on the solution’s strength category. This suggests the risk of overdose is low if used as directed. The bad news: the amount of nicotine contained in commonly sold refill bottles of e-cigarette solution is potentially lethal to children and adults when ingested in large quantities.

“E-cigarette solutions can be found in as large as one-liter containers,” said Howell. “If a small child drinks the liquid, severe poisoning or death could occur.”

She also noted that nicotine solutions come in a variety of flavors that could appeal to children and teens, such as bubble gum and chocolate.

Based on their findings, Howell and her colleagues are calling for FDA regulation and labeling requirements for e-cigarette solutions and caution parents to store these solutions away from children.

Study to Map Out Antipsychotic Drug Use in Washington

New research at WSU Spokane will explore patterns of antipsychotic medication use and associated side effects in Washington state’s Medicare population.

"Appropriate use of antipsychotic medications can significantly extend and improve the lives of people with schizophrenia and bipolar disorder,” said Jae Kennedy, associate professor of health policy and administration and the lead investigator on the study. "But it may also increase their risk for serious side effects, including heart disease, diabetes, and stroke.”

The study will use data from Medicare Part D claims to provide a detailed portrait of antipsychotic medication use in Washington at the regional and county levels. Kennedy and his team will assess whether patients are taking medications as prescribed, are taking multiple psychiatric drugs, or are using them for unapproved conditions. They plan to present the findings to state policymakers, mental healthcare providers, and consumers.

The two-year study is funded by a $340,289 grant from the state attorney general’s office.

A WSU clinical pharmacology professor who studies a group of rare inherited metabolic disorders has received a $743,974 grant from the National Institutes of Health to fund his latest research. In collaboration with colleagues from the National Institute of Neurological Disorders and Stroke and the Children’s National Medical Center in Washington, D.C., K. Michael Gibson is testing the effectiveness of the experimental drug SGS742 on succinic semialdehyde dehydrogenase (SSADH) deficiency, an inherited disorder with characteristics of autism and epilepsy.

SSADH deficiency causes a variety of neurological symptoms—including developmental delay, decreased muscle tone, intellectual disability, and seizures—as well as behavioral problems. The disorder is caused by mutations in the gene that produces the enzyme SSADH. SSADH is involved in breaking down a neurotransmitter known as GABA (gamma-aminobutyric acid), which prevents the brain from being overloaded with too many electrical signals. SSADH deficiency leads to an increase of GABA and a related molecule called gamma-hydroxybutyrate (GHB), particularly in the central nervous system. Scientists do not yet know how this increase causes the symptoms of the disorder, which is a key focus of Gibson’s research. SGS742, the experimental drug the researchers will be testing, targets a specific GABA receptor in the brain.

An extremely rare disorder with fewer than 200,000 known cases worldwide, SSADH deficiency may not be the only condition that could benefit from the trial, Gibson said. He noted that the study will also provide information for the potential treatment of a number of similar diseases, including inherited defects in GABA receptors and transporters. In addition, it may highlight potential add-on therapy for currently FDA-approved drugs whose pharmacological role is to elevate brain levels of GABA to reduce anxiety.